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NICE issues guidelines on neurological conditions

Help for GPs in identifying patients for referral

Jo Carlowe

Wednesday, 01 May 2019

The National Institute for Health and Care Excellence (NICE) has today published a guideline on recognising and referring people with suspected neurological conditions.

Research shows that some patients with neurological conditions had to see their GPs five or more times before specialist referral.


The new guideline offers, for the first time, comprehensive information on neurological conditions in general to help non-specialist healthcare professionals to identify people who should be offered referral for specialist assessment and care.

The guideline makes recommendations about which symptoms and signs should prompt a referral for further neurological assessment. It also covers some examinations, assessment tools and investigative tests non-specialists could use to help them decide whether a person with a suspected neurological condition should have further investigation or be referred to a specialist.

People with suspected neurological conditions often go to their GP with symptoms that are difficult to diagnose, which in turn can make identifying neurological conditions hard. A recent survey by the Neurological Alliance found that nearly a third of respondents had to see their GP five or more times about the health problems caused by their condition before being referred to a neurological specialist. It also found that around 40% of respondents waited more than a year from when they first noticed their symptoms to seeing a specialist.

Suspected neurological conditions account for about one in 10 GP consultations, and around 10% of emergency medical admissions (excluding stroke) and result in disability for one in 50 of the UK population.

The guideline aims to make a difference to anyone who might have a neurological condition by making sure:

  • GPs can recognise when symptoms could have a neurological cause
  • GPs and doctors in emergency departments know when to refer people to a specialist straight away and when to do more tests first
  • people who most need to see a specialist can see one sooner
  • people are not referred to a specialist if they don’t need to be.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “People with suspected neurological conditions often need referral to a specialist to be diagnosed. However, we know that some people with neurological conditions are initially misdiagnosed or have a delayed referral to a specialist, and some referrals are unnecessary. These issues with referral can come from non-specialists not recognising neurological conditions.

“This new guideline should help improve outcomes for people with suspected neurological conditions by providing, for the first time, a comprehensive assessment of the key signs and symptoms across the range of possible neurological conditions that should trigger referral to a specialist.”

Richard Grunewald, chair of the guideline committee, added: “A non-specialist cannot be expected to keep up with the rapid changes in knowledge and practice in clinical neurology. This new guideline will help non-specialists recognise patients with neurological symptoms, such as dizziness and sleep disturbance, to prompt their referral to specialist assessment and care.”

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